Did someone give you a blood pressure monitor as a holiday gift this year? Perhaps not the most exciting or entertaining of gifts, but thankfully someone has your heart health front of mind. And that’s a good thing, as monitoring your blood pressure and keeping it within normal range is one of the most important things you can do for your overall health as you age. In recent years, the range of “normal” versus “elevated” versus “high” blood pressure has changed, as more and more evidence has demonstrated the negative health consequences of high blood pressure. At this time, the goal is to intervene and prevent blood pressure elevation to high and dangerous levels as early as possible and to then have regular and ongoing monitoring to keep your blood pressure levels under control. For a good overview of blood pressure numbers and why it’s dangerous to let levels get out of control, extend your arm and click here.

This means that how you monitor your blood pressure- and how accurate the readings are- is critical. While you should always have a health care professional confirm your blood pressure readings, the reality is that even in professional offices, the use of blood pressure cuffs and the methods used to check blood pressure are not always proper or accurate, potentially leading to inaccurate readings that could put you on an inappropriate path. A recent article in The Wall Street Journal described what can go wrong and how even professional readings of blood pressure can often be mistaken. For example, your arm should always be supported by a table or surface, never dangling. Few medical offices are set up this way or have armrests for this purpose. You shouldn’t be scrolling on your phone or talking, and your bladder should be empty. Ideally, the measurement should be done a couple of times, and to do it properly it should take about 10 minutes, an allotment of time rarely available in a physician’s office. In fact, this article reports that a previous study of medical students showed that only 1 out of 159 students correctly measured blood pressure. A recent study published in JAMA Network Open reports that due to the wrong positioning of the arm when measuring blood pressure, millions of people may have been misdiagnosed with hypertension and incorrectly put on anti-hypertensive medications as a result. With an arm dangling or hanging at your side, gravity, muscle tension, or blood flow changes could mean your blood pressure may show a temporary increase.

There are also risks that the cuff on your blood pressure monitor may not be fitting correctly, which will again lead to an inaccurate reading. A recent study published in the journal Hypertension describes the problem of cuffs that don’t fit properly(and blood pressure should be measured by a cuff midway between your elbow and shoulder, not from your wrist). If a cuff is too small or tight (standard machines have a cut-off of arm circumference of 16.5 inches, which can be too small for many, especially Black adults) it can produce inaccurate results, suggesting that blood pressure is higher than it actually is.

It is recommended that older adults, especially those who have already been diagnosed with elevated blood pressure, regularly monitor blood pressure readings at home, underscoring the importance of accurate readings to discern changes. A recent research study has described the risk of cognitive decline – especially among older Black men- when blood pressure fluctuates. This further emphasizes the need for accurate readings at home. A recent article from Harvard Health Publishing describes the important considerations for accurately reading blood pressure at home, including sitting up in a chair, with feet flat, arm supported with a surface, and elbow positioned at the level of your heart. Your legs should never be crossed and the cuff of the machine should always be on bare skin. You should also avoid alcohol, caffeine, or exercise for 30 minutes before measuring. Geisinger suggests you bring your monitor to your doctor’s office so it can be checked to make sure it’s right for you. Consumer Reports recently published their list of the best home blood pressure devices and you can always look to see whether your machine is clinically validated by clicking here. Ultimately, the goal is to accurately track your blood pressure and keep it at a normal range as much as possible. But to do so, you need to first make sure you set yourself up for the best blood pressure readings possible.